Helicobacter pylori: A Class 1 Human Carcinogen - Greater Kashmir

iv. Avoid macrolide-based triple therapy if reported resistance rates are >15%, v. Previous exposure to macrolides should be taken into account while considering clarithromycin-based drug combination, vi. Amoxicillin therapy becomes an issue if there is a history of drug allergy and may need drug allergic testing, vii.

In case of a regimen failure, do not repeat any of the antibiotics in the second regimen, viii. As a general rule, 2 weeks of any regimen therapy gives better results. Some studies have shown similar results between 10 days versus 2 weeks of therapy. ix.

The main determinants of successful H. pylori eradication are the choice of regimen, the patient's adherence to a multi-drug regimen with frequent side effects, and the sensitivity of the H. pylori strain to the combination of antibiotics administered.

Fig 2 gives an account of numerous regimens which a clinician has available as a first-line and rescue therapy. Use off these to treat primary and resistant H. pylori infections needs considerable experience, understanding and patience.

Should we test for treatment success after H. pylori eradication therapy?

Whenever H. pylori infection is identified and treated, testing to prove eradication should be performed using a urea or ammonia breath test, fecal antigen test, or biopsy-based testing at least 4 weeks after the completion of antibiotic therapy and after PPI therapy has been withheld for 1–2 weeks.

What methods can be used to evaluate for H. pylori antibiotic resistance and when should testing be performed?

Although H. pylori's antimicrobial resistance can be determined by culture and/or molecular testing, these tests are currently not widely available routinely for clinical purposes.

How can we fight H. pylori globally?

There are two potential ways to fight H. pylori as a Class 1 human carcinogen and prevent the development of common and lethal non-cardia gastric cancer.

These include mass H. pylori eradication programs and the development of a vaccine. Long-term follow-up data from a randomized clinical trial carried out in Shandong China found that short-term treatment with antibiotics to eradicate H. pylori reduced the incidence of gastric cancer by 40% over a 15-year follow-up period. In recent years, a number of H. pylori vaccine development programs have been initiated.

All H. pylori vaccines currently in development are very early stages (Phase I or preclinical). These vaccines are predominantly composed of purified or recombinant components of H. pylori antigens with an adjuvant.

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